Affordable Care Act
Floor Speech
Mr. WHITEHOUSE. I am here today to talk about the health care problem in the country, because I think the fixation of this body on the health care Web site has taken our eye off the fact we have a very significant and fundamental health care problem.
This graph represents how much we spend on health care as a country. It begins back here in 1960. I was 5 years old in 1960. So this is a lifetime: 50-some years, $27.4 billion. That is what we spent on health care. Now here we are. This is up to 2011, and $2.7 trillion is what we spend on health care. It is 100 times as much in 50 years. Granted, there are more Americans but not 100 times as many.
This has been an explosive cost growth curve. When we were trying to pass the health care bill, that is what we were looking at for costs. It is a big competitive problem for our country.
This is a really interesting graph. I wish every time anybody talked about health care they would take 1 minute and look at this graph. I will explain briefly what it is.
This column is the up access and measures life expectancy in years, country by country, 65 to 85, where countries fall in terms of their average life expectancy for their population, for their citizens. This along the bottom is the cost, the health spending per capita per person in that country. So if you measure it all out, what you see is a great raft of countries all through here: Japan, Great Britain, Netherlands, Switzerland, Norway, Italy, Greece. There is a whole large group of countries right here, and all of them have a life expectancy 80 or older and they all spend between $6,000 and $2,000 per person on their country's health care. Essentially the entire modernized, civilized world is in that zone, from here to here.
Guess where the United States of America is. Boom. Here. We are below them all in life expectancy. We are trailing the pack of modern industrialized nations in our life expectancy. We are competing with Chile and the Czech Republic. But Japan, Greece, Great Britain, France, Germany, Luxembourg, all manage with their health care systems to achieve longer lifespans for their people. And we are doing it at a cost of about $8,500 per person per year.
To give a comparison, here are Switzerland and Norway. They are the other two most expensive countries in the world per capita on health care spending, and they are at about $5,700 per year. If we could bring our per capita health care spending in this country down to the most expensive countries in the world, if we could compete head to head with the most expensive countries in the world, we would save more than $1 trillion a year.
This is an interesting graph because it shows basically all the modern industrialized nations here, and it shows us here as a way outlier. It is a big deal for us to be an outlier here, because it means we blow about $1 trillion a year in wasteful and unnecessary health care which could be building infrastructure, solving problems, reducing the deficit, and could be doing other work. Instead, we spend it on a health care system which doesn't produce good health care results--at least not measured by life expectancy, which is a pretty good proxy.
There is a huge $1 trillion a year cost to our society in being that bad of an outlier. The cost is also measured in lost lives and lost years of life, because we are averaging 77 years and these countries are averaging 82 years of life.
We have a real problem on our hands, and obsessing about a Web site is a complete distraction from getting after this problem--5 years off every human's life in this country and $1 trillion a year. That is worth paying attention to.
The health care changes we brought are actually making a difference. Here are some interesting graphs. Each one is a projection done by the nonpartisan Congressional Budget Office of what health care costs are going to look like in the future, and what you see is a progression. They did this graph in August of 2010. This was where they projected health care spending would go when they projected in August of 2010 for this period, from 2014 onward to the next decade. A year later they went back and they projected again, and they projected actually costs would be lower. Then they came back in August of 2012 and they did another projection, and their projection showed that these anticipated costs went down again, every year, lower and lower.
Here is the big one. In May of this year, the Congressional Budget Office went back and redid its projections for Medicare and Medicaid spending from 2014 to 2023. Look how far below what they had projected 1 year ago, 2 years ago, and 3 years ago the current projection. That is a saving of about $1.2 trillion in that decade.
That is a long way from $1 trillion a year we could be saving if we just got back to where we were on this graph, if we got back from here to where Switzerland and Norway, the most expensive countries in the world, are. That is $1 trillion over 1 year. This is $1.2 trillion over 10 years, but it is still a big change and it is still moving in the right direction. So we shouldn't be too quick to condemn ObamaCare when that kind of savings is already being projected.
The last slide I will show before I go to Senator Cantwell, who has been good enough to join us, is this one. Why might it be that those costs went down so far in May of 2013? Why might it be that graph of projected costs keeps going down? It is because of changes in what is going on in the health care system.
This is one good example. This shows the hospital readmission rate from January of 2007 until August of 2013. This is how often somebody was discharged from the hospital, went home, and then within 30 days had to come back and be readmitted.
That could potentially be for a completely new reason, but usually it is because the discharge planning wasn't done well enough and there was a bad handoff between the hospital and the primary care physician or the nursing home. What we found is you could make that transition much better for patients. When you do, guess what. They don't get sent back to the hospital. When they don't get sent back to the hospital, you save money.
That is just one way the kind of huge $1.2 trillion over 10-year savings CBO has already projected could be taking place, but this is clearly a part of it. It is improving the quality of care so people aren't going back into the hospital, aren't going to the emergency room, and you avoid that cost at all by having handled the patient better, by having given them better treatment and better care.
It is pretty astounding. In 2007, right through here until the end of 2011, it was a pretty steady readmission rate. Then when we changed the signal to the hospitals and cut their payment for readmissions, boom, down it fell. That represents a very significant savings in the system. And in the personal lives of those people and their families not having to go back to the hospital, that is a pretty big plus too.
It was Senator Cantwell's idea that we should come down today and talk a little bit about the delivery system reform side of the health care discussion. I got started a little bit before she could get here, but my wonderful colleague now has arrived, so let me yield the floor to her. I will put this graph back because I want to leave this here for whenever the camera swings my way. I want people to see this graph. It is inexcusable that all of these competitive industrialized nations of ours should be able to deliver universal high-quality health care for what would be a $1 trillion a year savings if we could simply match them, and they produce a longer life expectancy for their people and we are stuck competing for life expectancy with Chile and the Czech Republic. Come on. We can do a lot better than that, and that should be the ball we have our eye on rather than obsessing about the ObamaCare Web site.
I yield the floor.
BREAK IN TRANSCRIPT
Mr. WHITEHOUSE. If I could ask the Senator another question in response to what she just said, not only is it a win-win, being lower cost and better quality care, but I believe the Senator said that there is actually a third win here. There is the win of lower cost, there is the win of better quality care, but for seniors there is a huge win of maintaining your independence and being able to stay at home. It is hard to put a price on that, but if you are facing the choice of having to leave your home and having to go to a more restrictive health care setting, being able to stay at home is a very big plus.
Really, it is not win-win, it is win-win-win.
BREAK IN TRANSCRIPT
Mr. WHITEHOUSE. Mr. President, in responding to what Senator Cantwell just said about the Congressional Budget Office, it indeed has been frustrating and bedeviling to run up against their inability to project these savings in a way that would allow us to--what we call in Washington--score them and get budget credit for them. But even though they have that difficulty, there are some very serious organizations that project that very significant savings of the kind I have mentioned--the $1 trillion savings--are possible.
Some years ago the President's own Council of Economic Advisers estimated that we could do savings of $700 billion without affecting the quality of care in any way for the worse.
The National Institute of Medicine has made several regular projections. The most recent one is $750 billion a year. The Institute of Medicine is pretty serious folks, and they are entitled to respect when they say we can have those kinds of savings.
RAND Corporation--a lot of people know a lot about it--is a very expert organization. They have done two things. They looked at what we can save in health care, and then they looked at what we can save in health care plus an additional bit for dealing with waste and fraud. They gave ranges for the two. The midpoint of the range for savings is about $730 billion. If we add their suggestions on waste and fraud, the midpoint of their range goes to about $910 billion a year.
The Lewin Group, which is another respected think tank that looks at health care issues, wrote a piece some time ago with George Bush's former Treasury Secretary, and they said it was $1 trillion.
So is it $700 billion a year? Is it $750 billion a year? Is it somewhere between $730 and $910 billion a year depending on how you score the waste and fraud? Is it $1 trillion a year? Either way, I will take it. Those are big numbers, and wherever it falls in that range, we should be energetically fighting for it.
I will close with the request I always make in these speeches--and this is a request to the President and to his administration--and that is to inspire us and set a bold national target. Sure, CBO, OMB, and our actuarial and accounting organizations cannot predict what these savings are going to be, but, by gosh, the President can direct his administration to target a savings goal and to go after it. I think if the President were to set a hard date and dollar target for delivery system savings--a couple of years out so we have a chance to do that--that would make a big difference.
The example that I use is of President Kennedy. Back in 1961, when it looked as if we were losing the space race to the Soviet Union, President Kennedy declared that within 10 years--he put a date on it--he would put a man on the Moon and bring him back safely. He had a hard target, something specific so you would know if it was or wasn't achieved. The message was clear, the mission that was outlined was clear, and the result was a vast mobilization of private and public resources to achieve that purpose.
It is not enough to talk about bending the health care cost curve. That catchphrase should be jettisoned and discarded. We should have a hard date and dollar figure, and that should be a target the entire administration aims toward.
Had President Kennedy given that speech back in 1961 and declared as his purpose to bend the curve of space exploration, I very much doubt we would have put that man on the Moon within 10 years. It was his exercise of Presidential leadership and challenge--ahead of what the scientists knew could be done but with confidence and faith in our ability to achieve big things--that put the executive branch of government into focus so we could achieve exactly what he had directed. We can do the same with health care. We should do the same with health care. There is no downside to it because this is a win-win area, as I discussed with Senator Cantwell.
On that note, I yield the floor and suggest the absence of a quorum.
BREAK IN TRANSCRIPT
Source